COMPARATIVE EFFECTIVENESS OF CARBAPENEMS VERSUS ALTERNATIVE ANTIBIOTICS FOR THE TREATMENT OF BACTERAEMIA DUE TO ENTEROBACTERIACEAE PRODUCING EXTENDED-SPECTRUM β-LACTAMASE IN DEFINITIVE THERAPY- A SYSTEMATIC REVIEW AND META-ANALYSIS
Author(s)
Son SK, Lee NR, Park JJ, Park DA
National Evidence-based Collaborating Agency, Seoul, South Korea
OBJECTIVES: The widespread use of carbapenems for patients with bacteremia due to Enterobacteriaceae producing extended-spectrum β-lactamase (ESBL) has accelerated the emergence of carbapenem-resistant enterobacteriaceae. We conducted a systematic review of the relevant publications that compared carbapenems versus alternative antibiotics for treatment of ESBL-positive bacteremia in definitive therapy. METHODS: We searched Ovid-Medline, Ovid-EMBASE, Cochrane library, and seven domestic databases until April, 2015, without the restriction of language and date. We selected the studies reported overall mortality in patients with carbapenems and alternative antibiotics such as β-lactam/β-lactamase inhibitor combinations (BL/BLIs), fluoroquinolones, cephalosporins, and aminoglycosides. RESULTS: Twenty one studies with 1,486 participants were finally included for this review. All included studies were observational studies. There were no significant differences in overall mortality rates between the carbapenems and four kinds of comparisons, such as BL/BLIs (OR 0.60 95% CI 0.28 to 1.29, I CONCLUSIONS: Although these findings suggest that carbapenems seems to be associated with similar mortality rate when compared several alternatives, such as BL/BLIs, fluoroquinolones, and aminoglycosides, in definitive therapy, these pooled data were insufficient to draw clear conclusion as lack of robust results based on randomized controlled trials (RCTs). Further well-designed RCTs are warranted for determining the treatment effect of carbapenems.
Conference/Value in Health Info
2016-10, ISPOR Europe 2016, Vienna, Austria
Value in Health, Vol. 19, No. 7 (November 2016)
Code
PIN3
Topic
Clinical Outcomes
Topic Subcategory
Comparative Effectiveness or Efficacy
Disease
Infectious Disease (non-vaccine)